Depression

Introduction

Depression is more than simply feeling unhappy or fed up for a few days.

We all go through spells of feeling down, but when you're depressed you feel persistently sad for weeks or months, rather than just a few days.

Some people still think that depression is trivial and not a genuine health condition. They're wrong. Depression is a real illness with real symptoms, and it's not a sign of weakness or something you can "snap out of" by "pulling yourself together".

The good news is that with the right treatment and support, most people can make a full recovery.

How to tell if you have depression

Depression affects people in different ways and can cause a wide variety of symptoms.

They range from lasting feelings of sadness and hopelessness, to losing interest in the things you used to enjoy and feeling very tearful. Many people with depression also have symptoms of anxiety.

There can be physical symptoms too, such as feeling constantly tired, sleeping badly, having no appetite or sex drive, and complaining of various aches and pains.

The severity of the symptoms can vary. At its mildest, you may simply feel persistently low in spirit, while at its most severe depression can make you feel suicidal and that life is no longer worth living.

Most people experience feelings of stress, sadness or anxiety during difficult times. A low mood may improve after a short time, rather than being a sign of depression.

When to see Dr. B C Shah

It's important to seek help from Dr. B C Shah if you think you may be depressed.

Many people wait a long time before seeking help for depression, but it's best not to delay. The sooner you see a doctor, the sooner you can be on the way to recovery.

Sometimes there is a trigger for depression. Life-changing events, such as bereavement, losing your job or even having a baby, can bring it on.

People with a family history of depression are also more likely to experience it themselves.

But you can also become depressed for no obvious reason.

Depression is quite common and affects about one in 10 of us at some point. It affects men and women, young and old.

Depression can also strike children.

Treatment

Treatment for depression involves either medication or talking treatments, or usually a combination of the two. The kind of treatment that Dr. B C Shah recommends will be based on the type of depression you have.

Living with depression

Many people with depression benefit by making lifestyle changes such as getting more exercise, cutting down on alcohol and eating more healthily.

Self-help measures such as reading a self-help book or joining a support group are also worthwhile.

Symptoms of clinical depression

The symptoms of depression can be complex and vary widely between people. But as a general rule, if you are depressed, you feel sad, hopeless and lose interest in things you used to enjoy.

The symptoms persist for weeks or months and are bad enough to interfere with your work, social life and family life.

There are many other symptoms of depression and you're unlikely to have every one listed below.

If you experience some of these symptoms for most of the day, every day for more than two weeks, you should seek help from Dr. B C Shah.

Psychological symptoms include:

Continuous low mood or sadness
Feeling hopeless and helpless
Having low self-esteem
Feeling tearful
Feeling guilt-ridden
Feeling irritable and intolerant of others
Having no motivation or interest in things
Finding it difficult to make decisions
Not getting any enjoyment out of life
Feeling anxious or worried
Having suicidal thoughts or thoughts of harming yourself

Physical symptoms include:

Moving or speaking more slowly than usual
Change in appetite or weight (usually decreased, but sometimes increased)
Constipation
Unexplained aches and pains
Lack of energy or lack of interest in sex (loss of libido)
Changes to your menstrual cycle
Disturbed sleep (for example, finding it hard to fall asleep at night or waking up very early in the morning)

Social symptoms include:

Not doing well at work
Taking part in fewer social activities and avoiding contact with friends
Neglecting your hobbies and interests
Having difficulties in your home and family life

Depression can come on gradually, so it can be difficult to notice something is wrong. Many people continue to try to cope with their symptoms without realising they are ill. It can take a friend or family member to suggest something is wrong.

Doctors describe depression by how serious it is:

Mild depression has some impact on your daily life
Moderate depression has a significant impact on your daily life
Severe depression makes it almost impossible to get through daily life – a few people with severe depression may have psychotic symptoms

Grief and depression

It can be hard to distinguish between grief and depression. They share many of the same characteristics, but there are important differences between them.

Grief is an entirely natural response to a loss, while depression is an illness.

People who are grieving find their feelings of loss and sadness come and go, but they're still able to enjoy things and look forward to the future.

In contrast, people who are depressed have a constant feeling of sadness. They don't enjoy anything and find it hard to be positive about the future.

Other types of depression

There are different types of depression, and some conditions where depression may be one of the symptoms. These include:

Postnatal depression. Some women develop depression after having a baby. Postnatal depression is treated in similar ways to other forms of depression, with talking therapies and antidepressant medicines.
Bipolar disorder is also known as "manic depression". It's where there are spells of depression and excessively high mood (mania). The depression symptoms are similar to clinical depression, but the bouts of mania can include harmful behaviour such as gambling, going on spending sprees and having unsafe sex.
Seasonal affective disorder (SAD). Also known as "winter depression", SAD is a type of depression that has a seasonal pattern usually related to winter.

Causes

There is no single cause of depression. You can develop it for different reasons and it has many different triggers.

For some, an upsetting or stressful life event – such as bereavement, divorce, illness, redundancy and job or money worries – can be the cause.

Often, different causes combine to trigger depression. For example, you may feel low after an illness and then experience a traumatic event, such as bereavement, which brings on depression.

People often talk about a "downward spiral" of events that leads to depression. For example, if your relationship with your partner breaks down, you're likely to feel low, so you stop seeing friends and family and you may start drinking more. All of this can make you feel even worse and trigger depression.

Some studies have also suggested you're more likely to get depression as you get older, and that it's more common if you live in difficult social and economic circumstances.

Stressful events

Most people take time to come to terms with stressful events, such as bereavement or a relationship breakdown. When these stressful events happen, you have a higher risk of becoming depressed if you stop seeing your friends and family and you try to deal with your problems on your own.

Illness

You may have a higher risk of depression if you have a longstanding or life-threatening illness, such as coronary heart disease or cancer.

Head injuries are also an often under-recognised cause of depression. A severe head injury can trigger mood swings and emotional problems.

Some people may have an (underactive thyroid (hypothyroidism) due to problems with their immune system. In rarer cases a minor head injury can damage the pituitary gland, a pea-sized gland at the base of your brain that produces thyroid-stimulating hormones.

This can cause a number of symptoms, such as extreme tiredness and a loss of interest in sex (loss of libido), which can in turn lead to depression.

Personality

You may be more vulnerable to depression if you have certain personality traits, such as low self-esteem or being overly self-critical. This may be due to the genes you've inherited from your parents, or because of your personality or early life experiences.

Family history

If someone else in your family has suffered from depression in the past, such as a parent or sister or brother, then it's more likely you will too.

Giving birth

Some women are particularly vulnerable to depression after pregnancy. The hormonal and physical changes, as well as added responsibility of a new life, can lead to postnatal depression.

Loneliness

Becoming cut off from your family and friends can increase your risk of depression.

Alcohol and drugs

Some people try to cope when life is getting them down by drinking too much alcohol or taking drugs. This can result in a spiral of depression.

Cannabis helps you relax, but there is evidence that it can bring on depression, especially in teenagers.

And don't be tempted to drown your sorrows with a drink. Alcohol is categorised as a "strong depressant" and actually makes depression worse.

Diagnosing clinical depression

If you experience symptoms of depression for most of the day, every day for more than two weeks, you should seek help from Dr. B C Shah.

It is especially important to speak to Dr. B C Shah if you experience:

symptoms of depression that are not improving
your mood affects your work, other interests, and relationships with your family and friends
thoughts of suicide or self-harm

Sometimes, when people are depressed they find it hard to imagine that treatment can actually help. But the sooner you seek treatment, the sooner your depression will lift.

There are no physical tests for depression, though Dr. B C Shah may examine you and do some urine or blood tests to rule out other conditions that have similar symptoms, such as an underactive thyroid.

The main way in which Dr. B C Shah will tell if you have depression is by asking you lots of questions about your general health and how the way you are feeling is affecting you mentally and physically.

Try to be as open as you can be with the doctor. Describing your symptoms and how they are affecting you will really help Dr. B C Shah understand if you have depression and how severe it is.

Any discussion you have with Dr. B C Shah will be confidential. He will only ever break this rule if there's a significant risk of harm to either yourself or others, and if informing a family member or carer would reduce that risk.

Treating clinical depression

Treatment for depression usually involves a combination of medicines, talking therapies and self help.

Treatment options

The kind of treatment that your doctor recommends will be based on the type of depression you have. Below is a short description of the types of treatment your doctor may recommend.

Mild depression

Wait and see - If you're diagnosed with mild depression, your depression may improve by itself. In this case, you'll simply be seen again by Dr. B C Shah after two weeks to monitor your progress. This is known as watchful waiting.
Exercise - Exercise has been proven to help depression, and is one of the main treatments if you have mild depression. Dr. B C Shah may refer you to a qualified fitness trainer for an exercise scheme or you can find out more about starting exercisehere.
Self help groups - Talking through your feelings can be helpful. It can be either to a friend or relative, or you can ask Dr. B C Shah to suggest a local self-help group. He may also recommend self-help books and online cognitive behavioural therapy (CBT).

Mild to moderate depression

Talking therapy - If you have mild depression that isn't improving, or you have moderate depression, Dr. B C Shah may recommend a talking treatment (a type of psychotherapy). There are different types of talking therapy for depression including cognitive behavioural therapy (CBT) and counselling. Dr. B C Shah can refer you for talking treatment or, in some parts of the country, you might be able to refer yourself.

Moderate to severe depression

Antidepressants - Antidepressants are tablets that treat the symptoms of depression. There are almost 30 different kinds of antidepressant. They have to be prescribed by a doctor, usually for depression that is moderate or severe.
Combination therapy - Dr. B C Shah may recommend that you take a course of antidepressants plus talking therapy, particularly if your depression is quite severe. A combination of an antidepressant and CBT usually works better than having just one of these treatments.
Mental health teams - If you have severe depression, you may be referred to a mental health team made up of psychologists, psychiatrists, specialist nurses and occupational therapists. These teams often provide intensive specialist talking treatments as well as prescribed medication.

Living with clinical depression

There are some key steps you can take to lift your mood and help your recovery from depression.

Take your medication

It is important to take your medication as prescribed, even if you start to feel better.

If you stop your medication too soon, you could have a relapse of your depression. If you have any questions or concerns about the medication you're taking, talk to your doctor or pharmacist.

It may help to read the information leaflet that comes with your medication to find out about possible interactions with other drugs or supplements. Check with your doctor first if you plan to take any over-the-counter remedies such as painkillers, or any nutritional supplements. These can sometimes interfere with antidepressants.

Exercise and diet

Exercise and a healthy diet can make a tremendous difference to how quickly you recover from depression. And they will both improve your general health, too.

Research suggests that exercise can be as effective as antidepressants at reducing depression symptoms.

Being physically active lifts your mood, reduces stress and anxiety, boosts the release of endorphins (your body's feel-good chemicals) and improves your self-esteem.

It also helps your mood to have a healthy diet. In fact, eating healthily seems to be just as important for maintaining your mental health as it is for preventing physical health problems.